Neurology

Botox suppresses involuntary tics

Joseph Jankovic, MD

The cosmetic cure-all Botox may have found another market: sufferers of Tourette's syndrome.

Researchers at Baylor College of Medicine in Houston are using botulinum toxin type A (Botox) to treat the neurological disorder, which can cause involuntary motor and vocal tics. Joseph Jankovic, MD, professor of neurology and director of the Parkinson's Disease Center and Movement Disorders Clinic at BCM, was the lead author of a recent article in the journal Clinical Pharmacology, which showed that Botox can suppress tics in disorders like Tourette's.

"While we have an enormous amount of data showing that Botox is an extremely safe and effective treatment for a variety of therapeutic and cosmetic uses, the important thing for patients is whether this translates into meaningful improvements in their daily lives," Jankovic said. "Our review makes clear that treatment with Botox accomplishes this across a wide range of chronic and debilitating disorders and conditions."

Although public awareness about Tourette's has generally improved since medieval times -- when it was thought to be demonic possession -- the disorder remains largely elusive to researchers and greatly misunderstood by the masses.

"We still don't know exactly what causes Tourette's syndrome, but we do know that it is a genetic disorder," Jankovic said.

Unlike most genetic disorders, Tourette's is caused by bilineal transmission, a rare event in which both parents contribute defective genes to their child. Nevertheless, the rate of Tourette's syndrome remains relatively stable -- roughly 3 percent of the population carries some form of the disorder, according to Jankovic.

"We have made tremendous progress with treatments, and even though we don't know the cause of the disease, we are able to significantly improve the quality of life for patients with Tourette's syndrome by a variety of medications," he said.

A common misperception of Tourette's is that coprolalia, the involuntary utterance of obscenities, is the predominant symptom, when actually less than half of all patients exhibit it. Furthermore, most people with Tourette's develop other behavioral problems such as attention deficit disorder and obsessive compulsive disorder.

In addition to Botox, medications like fluphenazine, pimozide and risperidol, which block dopamine receptors, suppress involuntary movements. Jankovic is also conducting studies with other drugs including tetrabenazine, an investigational drug that depletes dopamine, and topiramate, an anti-epileptic drug. Finally, new surgical procedures developed at BCM and The Methodist Hospital hold promise for curbing uncontrollable tics and other neurological problems associated with Tourette's.

"Tourette's clearly deserves more attention than it has been paid by either the scientific community or the funding agencies," Jankovic said. "For every patient we diagnose in our clinic, there are probably dozens who suffer the consequences of Tourette's syndrome without knowing that they have it."